Dislocation/Subluxation Management Or ‘I’m Just Popping Out for a While!’ Jason Parry Extended Scope Practitioner Clinical Specialist Physiotherapist Hypermobility What’s the Difference? Dislocation “Displacement of a bone from its natural position in the joint” (OED) Where the two bones that form a joint fully separate from each other. Dislocation Shoulder Elbow Subluxation Subluxate ‘To partially dislocate’ (CED) A partial dislocation of a joint Subluxation Knee Shoulder Dislocation/Subluxation § Can happen in any joint, but some are more common than others § Shoulder, knee, thumb, ankles Why? § Main reason – connective tissue § Support, bind together. § Framework for the body (ligaments, tendons) § Ligaments and tendons act like little ‘guy ropes’ Ligaments, Tendons, Capsules Quick Anatomy Lesson Collagen § The main structural protein of the various connective tissues in the body § Alteration in collagen causes the connective tissues to be more lax (stretchy) § Means that the collagen making up ligaments and tendons are more stretchy (more lax) § Joint capsule laxity § Means that joints are potentially less stable – hence subluxations and dislocations Other Reasons Too! § Altered muscle tone – fatigue, muscle patterning, spasm, stress § Impaired proprioception § Traumatic incident § Repeated overstretching - too many ‘party tricks’ ‘Party Trick’ ‘Captain Frodo’ – moves his body through a tennis racquet! ‘Just hanging around’ ‘The Snake Man’ entertaining French soldiers in 1915! It’s Out! § A regular occurrence? § 1 x week, 1 x day, 1 x hour, 1 x every 5 mins! § Joint slips back into place on its own But we still need to see if we can reduce the frequency for the future... Help – it won’t go back in! Understandable tendency to panic! Whoa There! Panic § More stress § Muscle spasms – pull the joint out of place § More pain § Less chance of resolving the dislocation What do I DO? Breathe! § Slow, deep, relaxed breaths § Try using some relaxation techniques What do I DO? Use Painkillers § Appropriate use of analgesia § Only take the dosage indicated by your prescriber. Never take more than the suggested dose What do I DO? Support the Joint § Use pillows or a sling § Find a ‘comfortable’ resting position § Allows the muscles to relax/stop spasming What do I DO? Try Heat § Hot water bottles, wheat bags, warm bath § Can help to relax muscles What do I DO? Distraction § Listen to music, watch a film, talk to friends/family, try relaxation CD/MP3 § Can be helpful as a short-term pain relieving strategy § Can help muscles relax What do I DO? Massage § Sometimes gentle massage will help to relax the muscles enough to be able to re-locate the joint The 6 Key Principles of Management 1. Breathe 2. Use painkillers 3. Support the joint 4. Try heat 5. Distraction 6. Gentle massage What’s the big idea? Main aims are to: § Stay calm § Keep on top of the pain § Allow the muscles to relax What if it doesn’t go back? § Don’t expect the joint to go straight back in § Not unusual for joints to remain out of place for hours or days § Once it’s out, it’s out – it’s not going out even more! When do I go to hospital/get help? § If the limb starts to change colour due to a lack of blood supply § If your limb goes completely numb § If you have tried the strategies above and are really struggling § Not unusual for ER to relocate joint for it to pop straight out again or when anaesthetic wears off § Need to learn to stay calm and self-manage What about damage? § Highly unlikely § Joint laxity allows for ligaments and capsules to stretch § Mostly distressing and unpleasant as opposed to damaging Learning Lessons § Reflect on the event § Were you moving in a way that normally causes the joint to dislocate? § Did you move without thinking? § What was your posture like? § Were you tired or overdoing it? § Were you stressed about something? Prevention § Physiotherapy to learn to control the muscles and use the right ones § Rehab to improve proprioception § Possible use of supports/braces if required § Try to manage stress and anxieties Stay Calm The more you stay calm and manage it yourself, the easier it should get each time! .